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Immune checkpoint inhibitor (ICI) therapy has played an important role in the treatment of several groups of cancers. Although a life prolonging treatment, many side effects have been shown with ICI therapy. This study looked at individual level clinical characteristics and outcomes with ICI therapy in patients who developed ICI-related myocarditis. A comprehensive review of the National Library of Medicine PubMed database was performed. Inclusion criteria were all studies that were composed of case reports and case series of individual patients undergoing ICI therapy that developed myocarditis. To appreciate individual patient level data, observational studies, clinical trials, systematic reviews, and meta-analyses were excluded. Our search yielded 333 results with 71 cases reviewed of ICI therapy-related myocarditis. The findings included an average age of 68 years, higher incidence in men, and pretreatment cardiac history of hypertension. Melanoma was the most prevalent malignancy with nivolumab being the most used ICI therapy. Heart failure was the most prevalent adverse event that was co-prevalent with myocarditis. Corticosteroid therapy alone was the most utilized therapy to treat ICI-related myocarditis. Mortality was seen in nearly half of the patient population. Our study reviewed the preexisting literature of prior reported myocarditis secondary to ICI therapy. Periodic surveillance should be performed by the cardio-oncologist and internist. Due to the expanding role of ICI therapy in treating a variety of cancer patients, appreciation of its impact on the development of myocarditis is needed. Cardiol Res. 2021;12(5):270-278 doi: https://doi.org/10.14740/cr1319

Amyloidosis is an infiltrative disease with severe impact on the cardiac anatomy resulting in structural changes 1 . Mitral valve insult from the infiltrative process, although rare, has been known to cause severe mitral regurgitation 4 . Due to underlying comorbidities these patients may not be surgical candidates. 17 , 18 , 19 , 20 The role of percutaneous mitral valve repair in cardiac amyloidosis has been described in a few prior cases. 4 , 15 We review the epidemiology, diagnosis, and treatment of cardiac amyloidosis. We also highlight prior cases described in the literature of cardiac amyloidosis and severe mitral regurgitation, while discussing the role of percutaneous mitral valve repair in these patients.

A 35-year-old female was admitted to the hospital for menorrhagia and fatigue. Initial labs revealed that the patient had severe thrombocytopenia and also tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main objective in this case is to describe the investigation that eventually led to a diagnosis of idiopathic thrombocytopenic purpura (ITP) in the setting of a SARS-CoV-2 coronavirus disease 2019 (COVID-19) infection and co-infection with Epstein-Barr virus (EBV). The majority of ITP cases are idiopathic and most are diagnosed and managed without hospital admission. Admission and careful management were warranted in this particular case. Interestingly, however, the patient did not have any respiratory complications associated with COVID-19. She was given 1 unit of platelets and subsequently received intravenous corticosteroids. Platelet counts improved and the patient was discharged with a course of oral prednisone. This case highlights the importance of understanding the differences between primary and secondary ITP.

Aortic stenosis (AS) and arteriovenous malformations (AVM) are a common coexisting pathology in the elderly. When both pathologies are combined, Heyde syndrome is a differential that is widely explored among clinicians. Unfortunately, this may not always be the case. We present a case of an 82-year-old female admitted for acute gastrointestinal (GI) bleeding with a history of AVMs and AS, as well as, an algorithm in diagnosing elderly patients with both pathologies.

Squamous cell carcinoma (SCC) of the urethra is a rare malignancy, comprising less than 1% of all malignancies. The annual age-adjusted incidence of urethral SCC is 4.3 per million in men and 1.5 per million in women. Due to the rarity of the disease, there are a limited number of prospective randomized controlled trials to evaluate the optimal management of locally advanced urethral SCC. Here, we present the case of a 47-year-old man with stage IIIB urethral squamous cell cancer that showed complete clinical and pathologic response to neoadjuvant chemoradiation with only 5-flurouracil after incomplete response to traditional chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP).

Background Clostridium difficile infection (CDI) is a known major financial burden. In the cancer population, CDI, was identified to have a peak incidence of 17.2 per 1000 patients with increased morbidity, mortality and hospital length of stay. The need to further elucidate chemotherapy (CTX) with vs. without ABX usage as risk factors among other variables in cancer patients arises since this population is already baseline immunocompromised. Methods A retrospective case–control study (total of 1989 cancer patients who received CTX and had diarrhea at UTMB through 1/2016–1/2018) was completed. Subjects were screened using extensive inclusion and exclusion criteria, and assigned as CASES (with symptomatic (s) diarrhea from proven CDI) and as CONTROLS (had diarrhea but not attributed to CDI). A 1:1 subject matching using age, sex and past medical histories was completed and a total of 46 patients: 23 cases and 23 controls were compared and analyzed. McNemar’s and independent t test of equal variance were used for association and comparing means/medians, respectively. Two-sided P value ≤ 0.05 was considered significant. Results The use of ABX (OR = 16, P = 0.0007) and having any degree of neutropenia at the time of diarrhea (OR = 12, P = 0.0055) among CTX patients had significant associations with having sCDI. Although no significant association between sCDI and # of days post CTX exposure (≥7 days (P = 0.1138) and ≥14 days post CTX (P = 0.1489) was identified, a mean of 12.83 ± 7.69 days passed before sCDI diagnosis in cases, compared with diarrhea diagnosis (7.46 ± 6.1 days) in controls (P = 0.0119). Meanwhile, receiving >1 CTX cycle (P = 1.000) and particular CTX types (P = ~ 0.0771–1.000) had no significant associations with sCDI diagnosis. Conclusion Any ABX usage post CTX exposure heavily predisposes to sCDI among cancer patients likely due to elimination of gut flora on an already predisposed population. Having any degree of neutropenia was also associated with having sCDI likely due to significant immunosuppression on top of being baseline cancer patients receiving CTX, and may have predictability benefits. The other variables may have not been significant due to expected limited cases because of low CDI incidence. Disclosures All authors: No reported disclosures.